New Health Affairs: Some Physicians Not Always Honest With Patients

Despite wide institutional acceptance of a medical professionalism charter that endorses openness and honesty in physicians’ interactions with patients, not all doctors comply, according to a survey whose results are published in the February 2012 issue of Health Affairs, released today.

Although about two-thirds of doctors responding to the survey did agree that they should disclose serious medical errors to patients, about one-third did not completely agree that they should.

Nearly two-fifths said they did not completely agree that they should disclose their financial relationships with drug and device companies to patients, and just over one-tenth said that, in the previous year, they had told patients something that was not true.

The findings don’t bode well for health care that is truly “patient centered” and focused first and foremost on the needs and desires of patients, says Lisa Iezzoni, lead author of the article incorporating the survey results and, a physician and professor of medicine at the Harvard Medical School and director of the Mongan Institute for Health Policy at Massachusetts General Hospital in Boston. “Patients who do not get the full story might not be able to make an informed choice about the best course of action for their care,” Iezzoni says. “Until all physicians take a frank and open approach to communication, it will be very difficult to enact patient- centered care more broadly,” she says.

Iezzoni and colleagues surveyed 1,891 physicians nationwide in 2009 to find out if they followed the standards on communication laid out by the ABIM Foundation’s Charter on Medical Professionalism. That landmark document, published in 2002, urges doctors to be open and honest with patients and to disclose medical errors promptly.

Although the vast majority of physicians completely agreed that physicians should fully inform patients about the risks and benefits of treatment, many admitted not always following the Charter’s standards on honest communication or maintaining trust with patients.

For example, nearly 20 percent of physicians said they had not fully disclosed an error to a patient in the previous year because they feared the admission would trigger a malpractice case. Iezzoni observes that these doctors expressed that concern even though research has shown that prompt communication about an error can reduce anger and make patients less likely to pursue a lawsuit.

Other important findings from the survey are as follows:.

More than 55 percent of physicians said they often or sometimes described a patient’s prognosis in a more positive manner than the facts might support. Physicians often rationalize this practice by saying they do not want to upset patients or cause them to lose hope. However, studies suggest that most patients do want to be told the truth, even if the outlook is dire, so that they can make the best possible decisions under the circumstances.

Women and under-represented minority physicians were significantly more likely to follow the Charter’s provisions on honest communication compared to white male doctors. The authors note that women and minority physicians have entered a field that historically has been dominated by white males. Women and minority physicians might feel compelled to rigorously adhere to standards of professional behavior, the authors say.

More than a third of physicians did not completely agree that they should disclose all financial ties with drug and device companies to patients, even though such ties can influence treatment. The authors point out that such information will soon be available to the public as a result of provisions in the new health care law.

As these and other provisions of the Affordable Care Act are implemented, physicians will be under increasing pressure to communicate honestly and effectively with patients, says Eric G. Campbell, associate professor of medicine at Harvard Medical School and the director of research at the Mongan Institute. Yet the survey clearly shows that some physicians have trouble accepting and living up to the tenets that underlie patient-centered care, says Campbell, who served as principal investigator on the survey and was a coauthor of the Health Affairs article.